The role of pulse oximetry. Its use as an indicator of severe respiratory disease in Peruvian children living at sea level. Respiratory Group in Peru.

OBJECTIVE

To evaluate pulse oximetry as a technique for diagnosing pneumonic and nonpneumonic acute lower respiratory tract infection (ALRI) in Peruvian children.

DESIGN

Children with acute respiratory infection were diagnosed with hypoxemia by pulse oximetry, with ALRI by the World Health Organization (WHO) algorithm and clinical examination, and with pneumonia by radiographic examination. Diagnoses were compared using kappa analysis.

SETTING

Pediatric emergency department.

PATIENTS

Peruvian pediatric patients with acute respiratory infection (n = 269) and well children (n = 162).

MAIN OUTCOME MEASURES

Hypoxemia (arterial oxygen saturation < 96.6% of the mean arterial oxygen saturation of well children -2 SD).

RESULTS

Children with pneumonic and nonpneumonic ALRI (59%, 160/269) had a mean (+/- SD) arterial oxygen saturation significantly lower than well children (93.8% +/- 3.5% vs 98.7% +/- 1.51%; P < .01). Pulse oximetry detected 88% and the WHO algorithm 90% of cases of pneumonic ALRI. The WHO algorithm and pulse oximetry detected 72% of radiologic pneumonia. Pulse oximetry misclassified notably fewer well children than did the WHO algorithm (4% vs 35%). Pulse oximetry and the WHO algorithm together (SATWHO) detected 99% and 87% of pneumonic ALRI and radiologic pneumonias, respectively, and both methods detected 94% of all cases of pneumonic and nonpneumonic ALRI diagnosed clinically.

CONCLUSIONS

Pulse oximetry and the WHO algorithm are practical, helpful, and appropriate for use in developing countries to identify children with pneumonic and non-pneumonic ALRI who require treatment. The SATWHO is highly sensitive for detecting children with ALRI.